Cesarian section CS is an obstetric operation which means the delivery of fetus through an incision in the abdominal wall and

the uterus. Today we will speak about the frequency of CS, indications and contraindications for this operation, types of CS, pain management strategies, elective repeat CS. CS was known in ancient time and it is widely discussed in literature that Cesar (time of Rome Empire) was born by means of this operation. Hippocrat performed CS in dying mothers. He tried to save their babies life. Till 19th century CS was performed very rare and all women died due to postpartum bleeding because the uterus wall was not sutured or due to postpartum infection. Only in 19th century Simmelweis recommended to wash up hands with carbolic acid before this operation. Thus 10% of all operated women survived after it. In 60th years of last century antibiotics entered in routine medical practice. It leaded to the significant growth of CS frequency from 5% in 1965 to 25% in 1990. Today the frequency of this operation varies from 15% to 20% in every maternity department. In big perinatal centers where most of women have severe pathology it reaches sometimes 40%. Why has it happened? In our days woman want to have a healthy baby and such definition as trial labor with unknown result does not suit her. It can be said about the labor in breech presentation, cephalic malpresentation, cephalopelvic disproportion, fetal distress syndrome. At the second ultrasound help us to make a diagnosis of giant baby or intrauterine growth restriction, true knots of umbilical cord. At the third assisted reproductive technologies such as in vitro fertilization or insemination give a unic chance for a woman to be a mother. CS can improve perinatal outcomes and decrease the rate of fetal morbidity and mortality but an excessive rate of cesarian sections in routine practice (more than 30%) does not do it. Indications There are many indications for CS. They can be divided in two big groups: Absolute Placenta previa Placental abruption Fetal distress Cephalopelvic disproportion Dysfunctional labor Malpresentation Failure to progress in labor Active genital gerpes Prolapse of umbilical cord Malignant tumor Severe somatic desease Pelvis tumor Multiple gestation Prior classical CS Selective Breech presentation Elective repeat CS Rh incompatibility Tear of rectum in anamnesis Some maternal conditions such as eclampsia and severe preeclampsia What is the difference between them? If you will manage the labor with absolute indications per naturalis the woman will die or the fetus will die. If you will manage the labor with selective indications, it can lead to disability or severe trauma.